Labour lies on health

June 9th, 2016 at 7:00 am by David Farrar

Labour have been going on for months claiming that health funding has not grown to keep up with our population and inflation. They cite a figure of $1.7 billion of under funding on this basis.

I made the mistake of assuming their figure was correct, and not checking up on it previously. I just assumed someone else would have.

But as I had some spare time last weekend I went through the Vote Health expenditure for the last decade. I then got the CPI figures and the resident population figures. And put them into the table below.

Health Funding

So health funding has increased by 35% in nominal terms. In real terms it has gone up 20% since 2008 and even in real per capita terms it is up 8.3%.

That’s pretty good considering the GFC and the Christchurch earthquakes led to huge deficits, which the Government also had to close.

More Doctors and Nurses

May 18th, 2016 at 2:00 pm by David Farrar


Jonathan Coleman announced:

As of 31 March 2016, there were over 7,880 doctor full-time-equivalents and 22,500 nurse full-time equivalents employed by DHBs – that’s almost 2,000 more doctors and nearly 4,200 more nurses compared to 2008.

In total the number of doctors and nurses working in DHBs across the country has increased by over 6,100 since 2008 – an increase of 25 per cent.

This includes around 1,100 more senior doctors, an increase of 36 per cent, and almost 1,100 more senior nurses, an increase of 40 per cent.

That’s a 23% increase in the number of FTE nurses and a massive 34% increase in the numbers of doctors. Not by coincidence there are now fewer managers and administrators.

Patient Portals

May 14th, 2016 at 2:00 pm by David Farrar

Jonathan Coleman announced:

Health Minister Jonathan Coleman is encouraging people to use a new online map to see whether their GP offers a patient portal.

“A growing number of general practices are introducing patient portals. These secure online sites are the health equivalent to online banking,” says Dr Coleman.

“Portals enable patients to book appointments, order repeat prescriptions and view lab test results online.

“You can have secure conversations with your GP via email, and in some cases, patients can also view their notes online.

“Portals are convenient, secure and real time savers for both the patient and staff at their general practice.

“A new interactive map launched today makes it easy for patients to check which general practices are offering portals. Patient portals are a great step towards enabling New Zealanders to manage more of their own healthcare.”

Over 330 general practices are now offering patient portals, with nearly 136,000 New Zealanders registered to use one.

The map is here.

You can quickly see which medical centres in Wellington City have a patient portal. They are:

  • Island Bay Medical Centre
  • Peninsula Medical Centre
  • Newtown Medical Centre
  • Newtown Union Health Service
  • Brooklyn Central Health
  • Brooklyn Medical Centre
  • Karori Medical Centre
  • Capital Care Medical Centre
  • Evolve Wellington
  • City GPs
  • Kelburn Medical Centre
  • The Terrace Medical Centre
  • Onslow Medical Centre
  • Johnsonville Medical Centre
  • Newlands Medical Centre

I’ve been using Manage My Health for a couple of years and find it great. The main attraction is being able to see which doctors are free when, and book yourself in. But lots of other good features also:

  • Can see your vaccination history and recalls
  • Blood Type
  • All test results
  • Previous prescriptions
  • Secure e-mail with doctors

Labour still thinks spending, not results, is what matters

May 13th, 2016 at 3:00 pm by David Farrar

Stuff reports:

Finance spokesman Grant Robertson mental health funding  was one of the “yawning gaps” in the health system. 

Labour figures showed his party increased health spending by an average of 8.1 per cent, while National had increased it by 3.4 per cent, he said.

“In the real world, that means people are not getting the surgeries they need, they’re not getting access to the mental health system, they’re not getting primary health care they need.” 

Health spokesman Annette King said Labour would fund health properly.

This sums up pretty much everything that is wrong with Labour. They think that what matters most is spending more money – rather than what that money actually achieves.

According to Labour, if DHBs manage to reduce their property costs by say $200 million, then that is bad as that is $200 million less spending. If DHBs save $100 million on accountants and increase spending on doctors by $50 million then Labour thinks this is bad because that is overall less spending.

I’m not sure Labour will ever get that what matters is results, not spending. Of course you need spending to achieve some things, but claiming an 8% annual increase in health spending is better than a 4% increase is focused on the wrong thing.

The reality is that almost every significant health indicator is better now than in 2008. A few are:

  • Youth smoking rates halved
  • Youth hazardous drinking rates halved
  • 100% of cancer patients now getting timely treatment, compared to 65% under Labour
  • 94% of patients being seen within six hours at ED, up from 70%
  • A 42% increase in the number of elective surgeries
  • An 18% increase in nurses and 27% increase in doctors
  • Immunisation rates up from 76% to 94%

Now if you go back to what Labour achieved despite their massive spending increases, well the answer will be not much. In fact the number of elective surgeries declined from 2000 to 2006.

Here’s the challenge for Labour. Don’t come up with a policy of simply promising more spending. Make a commitment on some outcomes.

DHBs achieving better results

February 26th, 2016 at 10:00 am by David Farrar

Jonathan Coleman released:

Health Minister Jonathan Coleman says good progress has been made in the quarterly health targets with improvements across all six areas.

“The health targets are not just about numbers – they are about delivering better faster access to services,” says Dr Coleman.

“The latest quarterly update shows improvements in elective surgery rates, shorter stays in ED, faster cancer treatment, increased immunisation, better help for smokers to quit, and more heart and diabetes checks.

“These results are a credit to health workers throughout New Zealand.

“Progress towards the new faster cancer treatment target improved six per cent, up to 75 per cent – the biggest quarterly increase to date.

“Delivering better cancer services is a top priority for the Government. We’ve made significant progress since 2008 and patients are getting better faster cancer care.

“The more heart and diabetes checks target was met for the second consecutive quarter. Around 1.2 million people have had their cardiovascular disease risk assessed in the past five years.

“The elective surgery target has again been achieved with 98,870 elective surgical discharges provided for the year to date – 4,890 more than planned.

Data on the targets is here. Some of the changes we have seen:

  1. 94% of ED patients dealt with in under six hours, up from 70% in 2008
  2. 98,870 elective surgeries year to date – up 42% from 2008
  3. 75% of cancer patients getting first treatment within 62 days (up from 66%)
  4. 100% of patients needing radiotherapy or chemotherapy start it within four weeks
  5. 94% of infants immunised on time, up from 76% in 2008. Rate of Maori is 91% and Pasifika 96%
  6. 96% of hospital patients who are smokers getting advice or support on how to quit (up from 17%)

This is stuff that really matters to people and makes a difference.

2014/15 NZ Health Survey

November 30th, 2015 at 10:14 am by David Farrar

Lots of interesting data in the latest NZ Health Survey.

Some changes from 2007 to 2015:

  • Smoking rate down from 20.1% to 16.6%
  • 15 to 17 year old smoking rate down from 15.7% to 6.1%
  • Maori smoking rate down from 42.1% to 38.1%
  • Drinking (alcohol) rate down from 83.6% to 79.5%
  • 15 to 17 year old drinking rate down from 74.5% to 57.1%
  • Hazardous drinking rate down from 18.0% to 17.7% (but up from low of 14.9% in 2011)
  • 15 to 17 year old hazardous drinking rate down from 19.5% to 10.8%
  • Obesity rate up from 26.5% to 30.7%
  • 15 to 17 year old obesity rate up from 12.0% to 16.4%

So my conclusions are:

  • Smoking rate steadily dropping and teen smoking rate has plummeted which is good. However 5% target for NZ will not be met without a big drop in the Maori smoking rate.
  • A huge drop in the teen drinking rate, which shows how wrong those are claiming the drinking age needs to increase
  • A drop in the overall drinking rate but an increase in the hazardous drinking rate which means measures should target hazardous drinkers, not all drinkers
  • The obesity rate increase starts young. Even under 5s have a 10% obesity rate, which suggests to me parenting is a major factor. Also cultural factors play a big role – 8% of European children are obese, 7% of Asian children, 15% of Maori children and 30% of Pasifika children.

King confuses minimum and average

November 18th, 2015 at 10:00 am by David Farrar

Stuff reports:

Shots have been fired over surgical figures, with the Health Minister accusing Labour’s Annette King of misleading Parliament by claiming Auckland DHB had raised its pain threshold for patients needing surgery. 

Auckland DHB has hit back saying it has not, and Health Minister Jonathan Coleman has accused King of deliberately “fudging the facts’. 

Misleading the house is a serious offence, which in some situations is dealt with by the privileges committee and the House has the ability to punish someone for contempt if that person is found to have deliberately misled it.

It is not clear that King deliberately misled Parliament. She may have been genuinely confused herself. But she should admit her mistake.

The allegations centred on figures tabled in the house last week, which King said showed Auckland DHB had lifted the points threshold for patients to qualify for hip and knee surgery from 50 points in 2013, to 70 points. 

But Auckland DHB has disputed their use, saying Labour’s research arm asked two different questions over the two information requests, with the 2015 request only asking for the average [Clinical Priority Assessment Criteria] score for those who had qualified. 

“This is a different question, and refers to the average acuity (severity of the condition) for patients who had received surgery for their hip or knee. We said 70.

“This is not the threshold for treatment,” a DHB spokesman said.

“The requests were for two different pieces of information which were provided. The two responses are not comparable as the request was for two different pieces of information.

One is a minimum, and one is an average. King is absolutely wrong in comparing the average in 2015 with the threshold or minimum in 2013.

From 15,000 to 21

August 20th, 2015 at 11:00 am by David Farrar

Jonathan Coleman announced:

“In the last financial year 322,196 patients across the country received a First Surgical Assessment, compared to 261,226 in 2008/2009. That’s an increase of 24 percent.”

In 2006 there were just over 15,150 patients nationwide waiting over six months for their First Specialist Assessment. Today there are just 21.

From 15,000 to basically zero. That is the sort of progress that is important to people.

And not just more and quicker assessments. There’re much more actual surgical operations being done also.

50,000 more elective surgery operations a year

August 14th, 2015 at 10:00 am by David Farrar

Jonathan Coleman announced:

Health Minister Jonathan Coleman says more New Zealanders are receiving the elective surgeries they need compared to seven years ago.

“As New Zealanders live longer lives, access to elective surgery is becoming more important than ever,” says Dr Coleman.

“Improving access to electives is a multi-dimensional goal. It includes reducing waiting times, increasing the number of First Specialist Assessments and elective discharges.

“The number of patients receiving elective surgery across the country has increased from 117,954 in 2007/08 to 167,188 in 2014/15. That’s around 50,000 more surgeries over the last seven years – a 42 percent increase.

“The elective surgery target of 4,000 more operations a year has again been exceeded in 2014/15 with over 5,000 electives carried out.

“This lift in elective surgery rates is a credit to the hard working health professionals working across the country.”

That’s an increase well in excess of population growth.

Herald on anti flu vaccine health workers and unions

August 5th, 2015 at 4:00 pm by David Farrar

The Herald editorial:

It beggars belief that any nurses employed in public hospitals would be allowed to decline vaccinations against winter flu. It strains credibility further to hear these nurses complain they are obliged to wear face masks in the wards. And it is nothing short of disgraceful their national union, supported by the Association of Salaried Medical Specialists, backs them up.

I agree.

The flu is not chicken pox. People die from the flu. Lots of people. Why would a hospital worker not want a free flu vaccine?

Plenty of people outside the public health services decline flu vaccines, even when provided free in workplaces. This is a free country and people are free to make unhealthy decisions for themselves, even when their decision reduces the immunity that can be provided for the community. The best health authorities can do is to promote and practise good sense, based on medical research.

Nurses and other health professionals are also free to question the wisdom of immunisation or any other medical practices if they wish, but if so they should look for a job with an alternative provider.

If you accept a job in a hsopital working with sick people who are especially vulnerable to illnesses such as influenza, then you lose discretion over whether or not to have a vaccine. Just as if you accept a job as a teacher, you may have a dress code to comply with.

And Waikato DHB hasn’t even made it compulsory. They’ve just said wear a mask, if you won’t get one – and you work in clinical areas.

You don’t want to catch the flu in hospital

August 1st, 2015 at 4:00 pm by David Farrar

The Herald reports:

Three Waikato Hospital nurses have been suspended for defying a controversial new policy forcing non-vaccinated workers to either get flu jabs or wear face masks.

Waikato District Health Board has defended its stance, saying any staff member who refused to comply could face the sack.

Last month, the board became the first in the country to make it compulsory for unvaccinated staff to wear masks, to protect employees and patients from the flu.

I think this is fair enough. Patients in hospital are vulnerable to sickness, and catching the flu from a nurse could literally kill you.

Nurses still have the choice – get vaccinated, or wear a mask.

“When considering that our employee numbers are in excess of 6,500, the reality is that almost all staff are getting on with doing their duties and they recognise that the intent of the policy is to provide a safer clinical environment for our patients and fellow employees,” the spokesman said.

But the Nurses Organisation sees the measure as a “punitive action” against staff, some of whom have turned to the union for support.

The DHB is putting the rights of patients not to catch the flu in hospital ahead of the rights of staff to give them the flu.

Annette being sensible

July 16th, 2015 at 4:00 pm by David Farrar

The Herald reports:

New Zealand ranks well down on the OECD’s list of countries with the most hospital beds, but health officials say it’s nothing to be concerned about.

Meanwhile, the Health Ministry has extended its free flu immunisation programme until the end of August due to the season’s expected late peak.

The Organisation for Economic Co-operation and Development (OECD) figures show New Zealand languishing at just 2.8 beds per 1000 people – the same as Ireland and United Kingdom – but well below leaders Japan, on 13.4, Korea, 10.3; Germany 8.3 and Australia 3.8.

But Labour’s health spokeswoman Annette King said while it could look concerning, it was also a positive. “The number of beds in hospitals has been decreasing over the years because … as technology and techniques have changed, the length of stay in hospital is reduced hugely. So the number [of beds] you need is reduced and so much more is done in the home.”

Yep. Number of beds is not a measure of healthcare.

Ministry of Health chief medical officer Don Mackie said hospital beds per capita was not a measure that by itself told people a lot about the quality of healthcare.

“Like many other comparable developed countries, New Zealand is moving to the modern trend of shorter in-patient stays and greater emphasis on care closer to home.

The number of beds is an input, not even an output let alone an outcome. We should focus on improving outcomes, not on whether we have more beds than the UK per capita.

Oamaru Hospital

July 7th, 2015 at 10:00 am by David Farrar

The Herald reports:

An estimated 2500 people showed up to protest proposed funding cuts to Oamaru hospital today.

Waitaki mayor Gary Kircher said he was very pleased at the community’s support.

Marchers ranged from families to the elderly, which Mr Kircher said sent a message about the community’s attitude to the local health service.He said they were very passionate about the primary level hospital, and even though it was a basic service, the community did not want any further cuts.

Mr Kircher said expecting residents to go to Dunedin for specialist care due to funding cuts was unacceptable.

The article is not clear about what is regarded as specialist care, but as a general point I’d note that it is unrealistic to expect a town of 14,000 to have much in the way of specialist care. They should have a hospital, but you are just never going to be able to have the same quality and breath of service as in a city such as Dunedin.

Oamaru has around the same population as Tokoroa and Feilding.

Now it seems the march is specifically about the SDHB proposing a 5% funding cut,  and it is legitimate to have concerns about that. But a sweeping statement that one shouldn’t have to go to Dunedin for specialist care is silly.

98% of under 13s now get “free” GP visits

July 4th, 2015 at 7:00 am by David Farrar

Stuff reports:

A Government offer to subsidise free doctors’ visits to children under 13 has been taken up by 96 per cent of GP practices throughout New Zealand.

Health Minister Jonathan Coleman said the rate had far exceeded expectations.

“Of the 1012 general practices in the country, 96 per cent have opted in for free medical appointment, covering 98per cent of children aged under 13.”

That included rural practices too.

“It’s going to make a real difference, because families aren’t going to have to think twice about going to see the doctor,” he said.

The Government announced the $90 million programme as part of last year’s Budget, making children under the age of 13 eligible for free general practice visits and prescriptions from July 1.


I comment on this because a couple of months ago the Greens were claiming that the Government had not set the level of subsidy high enough, and that only 90% of families would be covered. I pointed out that the Greens were effectively calling for the level of subsidy to be set at the whatever the most expensive GP in NZ charges. The results show that the Greens were wrong in their claims.

Perioperative Mortality

June 17th, 2015 at 10:00 am by David Farrar

An interesting report on perioperative mortality in NZ. It’s great that we have such transparency of data.

The mortality rates within 30 days of an operation are:

  • Coronary artery bypass graft 2.47%
  • Percutaneous transluminal coronary angioplasty 1.66%
  • Hip arthroplasty 1.58%
  • Cholecystectomy 0.37%
  • Knee arthroplasty 0.17%
  • General anaesthesia 0.12%
  • Bariatric surgery 0.07%

There is a huge difference based on you ASA score. The ASA scores are:

  1. Healthy person 0.05%
  2. Mild systemic disease 0.05%
  3. Severe systemic disease
  4. Severe systemic disease that is a constant threat to life 16.9%
  5. A moribund person not expected to survive without the operation 52.8%
  6. A brain-dead person


DHBs improve towards health targets

May 27th, 2015 at 2:00 pm by David Farrar

Jonathan Coleman released:

Health Minister Jonathan Coleman says the latest quarterly health target results show the shorter stays in emergency departments target has been met for the first time.

“DHBs are continuing to improve their performance on the Government’s health targets,” says Dr Coleman.

“Across the country over 250,000 New Zealanders were admitted, discharged or transferred from an emergency department within six hours. Achieving the 95 per cent target for the first time is a significant achievement.

“The number of patients presenting to emergency departments continues to increase. In quarter three, 4,481 more people attended an emergency department compared to the last quarter.

“Reaching the target is a tribute to all the staff working within emergency departments and DHBs. We know that emergency departments only work well when the rest of the hospital is working well too.”

The improved access to elective surgery and the hospital component of the better help for smokers to quit targets were also met:

Here’s the latest national data, and how it compares to the past:

  • ED treatment within six hours – 95%, up from 70% in 2008
  • 123,585 elective surgical procedures in 9 months compared to 118,000 for all of 2008
  • 67% get cancer treatment within 62 days of referral
  • 100% get radiotherapy or chemotherapy within four weeks of decision to treat, up from 65% in 2008
  • 93% of infants immunised compared to 76% in 2008
  • 96% of hospitalised smokers given advice on how to quit, up from 17% in 2010
  • 89% of smokers seeing a primary care professional given advice on ow to quit, up from 30% in 2013
  • 88% of eligible population have had a cardiovascular risk assessment in last five years, up from 46% in 2012

Once again we see the benefit of having a health system focused on eight or so goals, rather than the 50+ there were under Labour, almost none of which were achieved.

The real credit should go though to the doctors and nurses in the DHBs and primary care professionals. They’re done really really well to get such improvements, backed up by extra funding.

5,500 more doctors and nurses

May 21st, 2015 at 7:00 am by David Farrar


The graph shows the increase in full-time equivalent doctors and nurses in our public health (DHBs) system. Considering the impact of the GFC, and the need to get back into surplus, that is a significant achievement.

$98 million more for surgery

May 7th, 2015 at 11:56 am by David Farrar

Jonathan Coleman announced:

An extra $98 million will be invested in Budget 2015 to provide more New Zealanders with timely elective surgery, and to improve the prevention and treatment of orthopaedic conditions, Health Minister Jonathan Coleman says.

“Access to elective surgery is a top priority for the Government. Elective surgery makes a real difference to patients and their families – it reduces pain, increases independence, and improves quality of life,” Dr Coleman says.

“The number of patients receiving elective surgery has increased from 118,000 in 2007/08 to 162,000 in 2013/14. That’s 44,000 more operations – a 37 per cent increase.

Considering the fiscal circumstances of the last few years, that’s a very significant increase. There will always be unmet demand, but there has been significant extra funding over the years to increase capacity.

Much ado about nothing

April 21st, 2015 at 1:04 pm by David Farrar

Stuff reports:

Not all children will receive free GP visits as promised by the Government, according to documents revealed by the Greens.

That’s because they have never promised it. It is impossible to promise it as GPs do not work for the Government and the Government can not set their fees for them – unless you nationalise the entire primary healthcare sector.

ACC Minister Nikki Kaye has set the funding level at a rate that will only cover an estimated 90 per cent of doctors’ visits for children who are injured, Radio NZ has reported.

At last year’s election the Government campaigned on making doctors’ visits and prescriptions free for all children under 13 from July this year.

However the Green Party has called out Kaye for deciding 90 per cent coverage was close enough.

This shows a misunderstanding (either deliberate or not) of how the funding level is set.

GPs around NZ will currently charge a wide variety of fees for under 13s. For example some may charge $10 and some may charge $30. Each GP practice can be different to reflect their costs – rent, salaries etc. These are different in Epsom and in Rotorua, for example.

The Government set the funding at the level at which 90% of GPs are currently charging. Now this doesn’t mean that 10% of GPs will still charge a fee. If for example the subsidy is $30 and your charge was  $32, you may well decide that it is not worth the hassle, or the bad publicity, to charge a $2 part fee.

Over time more and more GPs will not charge a part fee, because if they do it is bad publicity, and patients may move.

Coleman and Kaye point out:

“We expect levels of uptake by general practices of the free under 13s scheme to be similar to uptake of the under 6s scheme,” says Dr Coleman.

“Currently 98 per cent of general practices offer free doctors’ visits for under 6s. Initial uptake was 70 per cent in January 2008, and it has steadily increased to current levels. There are only around twelve general practices in New Zealand that are not offering free under 6s doctor visits.”

So the fact the funding is set slightly below the level at which the 10% most expensive GPs charge, doesn’t mean you don’t get close to universal coverage.

But less us look at what the Greens are actually arguing for, and you will see that they are actually arguing for an incredibly appalling waste of scarce health dollars.

They are saying that the level of subsidy should be set at the level above which 100% of GPs currently charge.

Now think about that. The Greens are saying that the subsidy to GPs should be based on what the most expensive GP in NZ charges.

This would result in a massive wealth transfer to GPs. 99% of GPs would get a higher subsidy from the Government, than they were previously getting from patients. This would cost tens of millions of dollars.

And what would be the benefits to families? Well possibly it could result in no part-charges to the families who live in the areas with the most expensive GPs. These are generally the very wealthy suburbs such as Epsom, Wadestown etc. So the richest families in NZ would be the ones who benefit by not having a small part-charge.

I don’t have the exact numbers, but a ballpark estimate is that the cost per additional family subsidised to taxpayers and levypayers would be over $1,000!

You would be spending tens of millions more to eliminate part-charges for a handful of the wealthiest families.

The losers would be every family in NZ who pays tax and ACC.

The winners would be every GP in NZ, and the families who live in the wealthiest areas.

A huge transfer of wealth from middle income and low income NZ to the wealthiest. What the Greens call income inequality – and they are demanding it.

So I’m glad the Greens aren’t in Government, and that the subsidies are set at a sensible point such as the 90% level, rather than having the most expensive doctor in NZ determine the subsidies for the entire country.

A misleading story

April 5th, 2015 at 2:00 pm by David Farrar

Stuff reports:

Seeing a doctor is becoming a luxury item as housing costs take a toll on family budgets, Christchurch social agencies say.

“We have a number of families who don’t even take their children to the GP until they get really sick and often that’s because they’ve got debts and doctors sometimes won’t see a family until they have cleared previous debts,” Christchurch Methodist Mission executive director Jill Hawkey said.

I don’t know of any GP that will refuse to see a child because the family owe them money. They may ask the parents to arrange to pay their debts, but they won’t refuse to see a child.

One family with an outstanding bill of $30 were threatened by debt collectors with fees in excess of $1000 unless they paid up, she said.

That sounds preposterous, and I doubt it.

Nine practices in Canterbury operate under the Government’s Very Low Cost Access (VLCA) scheme and 298 Youth Health Services provides free GP visits for 10-24-year-olds.

It is worth remembering that taxpayers not subsidise free GP visits for children up to the age of 13.

This story is based on anecdotes and claims by an NGO. It would be a better story if it referenced actual data, such as the annual NZ Health Survey by the Ministry of Health. The latest survey finds:

  • children who did not visit a GP due to cost in the last year decreased from 6.3% to 5.2%
  • children who did not visit an after hours service due to cost decreased from 4.5% to 3.6%

I’m not saying there shouldn’t be an article on the claims that some families can’t afford primary healthcare. What I’m saying is that the article just repeated claims that had no substance, and didn’t seek out any data that contradicts that.

What should the public health system fund?

February 20th, 2015 at 2:00 pm by David Farrar

Stuff reports:

The letter comes after Christchurch weight loss blogger Elora Harre, posted on her Facebook page, the Shrinking Violet, that she had been refused excess skin removal surgery during a consultation with a plastic surgeon at Christchurch Hospital on Friday.

She was told she was a “perfect candidate” but the hospital lacked resources to operate, she said.

“Why is it that despite the fact we are quickly becoming an obese nation, for someone who has done what I was asked and lost the weight that could’ve cost our public health system A LOT more, that there is no resource for me?” she wrote.

She said the excess skin on her stomach, inner thighs, calves, lower back, arms, breasts and armpits caused her both psychological discomfort and physical discomfort, including a recurrent staph infection in her navel.

The post, which has attracted more than 600 “likes”, called on her thousands of followers to email Christchurch hospital general manager Pauline Clark and Minister of Health Jonathan Coleman in support of her cause.

I have some sympathy for Ms Harre’s cause. By losing weight naturally she has saved the health system money, and specifically could have been eligible for gastric bypass surgery which is very costly. It would arguably be a nice incentive that if you lose weight without surgery, you could qualify for some cheaper cosmetic surgery to remove excess skin.

However with limited resources it is hard to argue it is a priority:

Christchurch Hospital’s clinical director of plastic surgery has responded to criticism from a woman who was refused excess skin removal following her 55-kilogram weight loss.

In a letter to, Dr Barnaby Nye wrote of the challenge of delivering health care in a budget-constrained environment. …

In his letter, Nye did not wish to comment on individual cases, but offered hypothetical case studies of patients he may treat, including a woman with carpel tunnel syndrome, and a man requiring jaw reconstruction after cancer removal.

“Every one of these patients lives will be improved with surgery,” Nye wrote.

“We are tasked with drawing a threshold to treat patients in the public system and must weigh the benefits for each of these … Our budget demands a certain number of cases be done per year but with limited operating time, operating on [one person] potentially denies more than 30 [other people] the chance of treatment.”

It is hard to say that the clinicians have their priorities wrong.

Our improving health

December 24th, 2014 at 10:00 am by David Farrar

The annual NZ Health Survey was published this month. It is interesting to compare results with 2006/07. These include:

  • Over 75s who say they are in good or better health up from 80% to 87%
  • Smoking rate down from 20% to 17%
  • Under 18 smoking rate down from 16% to 8%
  • Hazardous drinking rate down from 18% to 16%
  • Under 18 hazardous drinking rate down from 20% to 14%
  • 18 – 24 year old hazadrous drinking rate down from 43% to 33%
  • Under 18 drinking rate down from 75% to 59%

Issues that matter – Health

September 12th, 2014 at 1:00 pm by David Farrar



In 2008 only 65% of people requiring cancer treatment got it within four weeks. Many had to go to Australia to get treatment. Today every DHB has 100% of people needing cancer treatment getting it within four weeks. Source: Ministry of Health National Health Targets.



The best way to reduce smoking, is for young New Zealanders not to take it up. In 2007 15.7% of 15 to 17 year olds were smokers. In 2013 this rate had reduced to 8.0%. Source: Ministry of Health Public Health Survey. Note I don’t think this change is not necessarily related to who is in Government, but think it is important to make the point that the trend is very positive.



In 2008 the public health system provided 118,000 elective operations. In 2013/14 it was 161,933. A huge increase of 44,000. Source: Ministry of Health National Health Targets.

Surgery Growth


From 2003 to 2008 the number of elective operations increased by 2,950 a year. Since 2008 it has increased by 7,368 a year. Source: Ministry of Health National Health Targets and National Party.



Recall all the moral panic over youth drinking.  Well the Ministry of Health Public Health Survey shows that in 2007 19.5% of 15 to 17 year olds were hazardous drinkers and in 2013 only 8.1% were – almost half as many. Source: Ministry of Health Public Health Survey.



That’s 3,289 more nurses, 1,589 more doctors and 1,000 fewer health managers and administrators since 2008. Source: National Party Health Policy.



This is the change in percentage terms. Source: National Party. A 17.8% increase in nursing numbers and 26.8% increase in doctor numbers.



In 2008 only 70% of people in Emergency Departments were treated within six hours. In 2014 it was 94%. Source: Ministry of Health National Health Targets.



In 2008 only 76% of two year olds were immunised (on time). In 2014 it was 93%. Source: Ministry of Health National Health Targets.

These are not abstract changes. These are changes that make a huge impact on people’s lives. Few things are more important than quick cancer treatment, shorter emergency department stays, more immunisations and more elective operations. Plus on top of that the youth rates for smoking and hazardous drinking has almost halved.

These are issues that matter.

Stuff that matters – cancer treatment

August 29th, 2014 at 10:00 am by David Farrar

Tony Ryall announced:

If your doctor suspects you have cancer, the Government will ensure you see a cancer specialist and receive treatment faster than ever before. …

“We inherited cancer services which were failing New Zealanders. Patients were waiting months for treatment and some had to travel to Australia because of lengthy delays here. Thankfully those days are over – all patients now receive radiotherapy and chemotherapy treatment within four weeks of being ready to treat.

“We will build on our successful plan and introduce a new national health target which will ensure cancer patients receive their diagnostic tests, surgery, chemotherapy and radiotherapy even faster.

“If your GP suspects you have cancer, you should see a cancer specialist within two weeks. Diagnostic tests and clinical investigations will be completed in a faster, more streamlined way and our goal is for patients to receive their first cancer treatment within a maximum 62 days of their original GP’s referral.

“The new target is much broader than the current cancer health target, which focuses on how long patients wait to start their chemotherapy and radiotherapy when ready to treat. The current cancer target didn’t include surgery, which is often the first treatment step for patients, or the time patients wait to see a cancer specialist and have tests done.

“The maximum 62 days is an international gold standard for cancer treatment. Currently in New Zealand around 60-65 per cent of patients receive their first cancer treatment within this time.

“The new target will be for 90 per cent of patients to receive their first treatment within a maximum 62 days of seeing their GP by June 2017.

This is stuff that matters.

Cancer waiting times were abysmal under the last Government. Not on purpose, but because the health system had little clear focus. With something like 100 different health targets, it was a mess.

Ryall has managed to focus the health system on a few achievable but very important targets such as faster treatment for cancer, more immunisations, quicker A& visits, more elective surgery, better quit smoking help, and more health checkups. And the great thing is that doctors and nurses and health managers have shown an ability to meet, and sometimes exceed, these targets when they are have a clear focus.

This stuff literally saves lives.

A sensible oldie

August 12th, 2014 at 10:00 am by David Farrar

The Herald reports:

There were tough questions, soft questions, and sometimes no questions at all as Labour leader David Cunliffe took to the Auckland suburbs of Glen Innes, Onehunga and Tamaki yesterday to sell the party’s policies.

Fresh off his announcement that all over-65s, pregnant women and children under 13 would get free GP visits and prescriptions, Mr Cunliffe visited Onehunga Mall.

But it was a shaky start, as a gentleman threw up his hands in a flutter in an attempt to avoid shaking Mr Cunliffe’s hand.

And Colleen Whitehouse, 77, said she didn’t want Labour’s healthcare policy. “I think it would cost the country too much money.”

It wold, and far more than they say. Labour constantly make the mistake of never allowing for the fact that if you don’t charge for something, then far more people will use it.  Student associations used to give away free “hardship” money and every year they would report how surprised they were that more and more students would turn up wanting free money.


This graph is from the Dim Post, where Danyl points out:

Labour’s policy is a generous subsidy to the least needy group in the country. It’s also a very large group of people with high health-care needs and giving them ‘free’ access to healthcare is going to cause a huge increase in demand for primary health services.

Labour is promoting higher taxes on families and businesses of up to $5 billion a year, so they can increase subsidies to the “least needy”. Our aging population already poses massive fiscal challenges to us in terms of affordable healthcare and superannuation. Labour’s policy will make future healthcare even more unaffordable.